Sex-related differences in care and prognosis in acute coronary syndrome.

Objective: This study investigates differences based on sex in prognosis for acute coronary syndrome using data of 76,153 patients in Hungary's National Myocardial Infarction Register, focusing on all-cause mortality, risk factors, and treatment outcomes. Methods: The data set analyzed is the result of mandatory reporting on patients presenting with acute coronary syndrome to hospitals in Hungary. The current study comprises a retrospective analysis of all cases reported to the registry from 2014 to 2019. The primary outcome measured was all-cause mortality, with an average follow-up of 3.6 years. Results: The patient cohort had a median age of 67.4 years; females were on average seven years older. Women had a less favorable cardiovascular risk profile, obtained less optimal treatment, experienced more complications, and were less likely to receive guideline-consistent therapy. An age-adjusted analysis demonstrated that age significantly influences risk profiles, types of acute coronary syndrome, treatment strategies, and outcomes. The unadjusted mortality rate for females was significantly higher; however, multivariable analysis indicated that a worse short-term prognosis was contrasted by a better long-term prognosis when comparing females to males. Conclusions: This study highlights the need to further understand and address sex differences in the presentation and management of acute coronary syndrome. The noted higher mortality rates in female patients reveal the necessity for tailored, age-adjusted treatment strategies. Women often present with more advanced cardiovascular risk profiles and face barriers to timely care, making equitable access essential. Understanding the interplay between age, sex, and comorbidities is key to improving patient outcomes.